#2787 HOSPITAL MANAGEMENT OF AN INTEGRATED CLINICAL PRACTICE UNIT OF VASCULAR ACCESS FOR HEMODIALYSIS: A CHALLENGE FOR IMPROVING HEALTHCARE QUALITY?

Abstract

Abstract Background and Aims Vascular access (VA) for haemodialysis (HD) is essential for renal patients due to its high morbimortality and economic cost. Integrated Clinical Practice Units (ICPU) allows health organizations to establish comprehensive care, improve the quality and safety of care processes, as well as favor the accessibility of health care. The VA multidisciplinary teams for HD are crucial in the proper management of VA, although their implementation in daily clinical practice is not fully consolidated. The aim of this study was to analyze the effectiveness of the healthcare processess in patients with VA for HD after the creation of our ICPU focused in the multidisciplinary management of the VA (FUVA) through quality of care indicators. Method 12 years retrospective unicentric study analyzed in two periods: first period (2010-2015) and second period (2016-22) after FUVA creation. The indicators include sociodemographic data, processes activities (first and successive visits, endovascular procedures, type and number of surgical interventions, delayed time for interventions, mean hospitalitation stay, and results oriented to the patient's quality of life (VA initial assessment and dysfunction, inpatient and outpatient VA interventions). Results 551 VA for HD hospital admissions r were performed (53.2% in charge of nephrology, with 893 total days of stay and mean stay of 3.6 days), 670 surgical interventions (69.7% native fistulas, 47.3% admitted, 37±9.7 days of surgical delay) and 320 endovascular procedures (28.1% admitted, 11 ± 1.2 days delay). After the creation of the ICPU (FUVA), a total of 631 visits (96% first visit) were made in 451 patients with mean age 65.7 ± 17.5 years (66% men), 495 VA Doppler ultrasounds, 287 HD catheter placements (54.1% permanent, 29.2% left) and 84 withdrawals. Similarly, in this period there was a decrease in the number (160 vs 130) and percentage (92.4 vs 34.3%) of VA for HD admissions, a shorter surgical delay time (39 ± 9.3 vs 32 ± 9.1 days) and a reduction in the mean hospital stay (3.7 vs 2.9 days), respectively. Similarly, outpatient management of all endovascular procedures performed (187) was achieved without repercussion on the waiting time for the procedure (11 ± 0.9). Conclusion In our study, the hospital management of VA for HD through the creation of an UPCI, allowed a more efficient management of the available care resources through the continuity of care of the process, favoring the integral and integrated care of the patient as well as contributing to the improvement in the management and survival of VA for HD. Similarly, elaboration and analysis of helathcare indicators have been useful tools in the evaluation of the quality of healthcare of our vascular access unit.